The following is a conversation between Robin Koval, President and CEO of Truth Initiative, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer.
Denver: One of the great public health stories in recent times has been the reduction in teen smoking. Now, there have been a lot of contributing factors to the success of this effort, but no one – and I mean no one – has played a more significant role than the Truth Initiative, formerly known as the American Legacy Foundation. And it is a great pleasure to have with us this evening their President and CEO, Robin Koval. Good evening, Robin, and welcome to The Business of Giving!
Robin: Well, thanks for having me!
Our mission is to achieve a culture where youth and young adults reject tobacco…
Denver: Robin, give us an overview of the mission and goals of the Truth Initiative.
Robin: So our mission is to achieve a culture where youth and young adults reject tobacco – big mission– but very, very achievable. And the way we go about doing it? We have three major programs: The Truth Campaign, which is our youth public education program, has been around since 2000. It’s where we do most of our work; but we also have a research and policy center where we do a lot of the foundational research in the area; and then our community and youth engagement work where we take what we do with 30,000 feet in the Truth Campaign and really bring it down into the communities. For instance, we have a wonderful tobacco-free campuses program that we’re doing with HBCUs (Historically Black Colleges and Universities) and community colleges.
Denver: How did this organization come into being?
Robin: Well, you might remember, back in 1998, still the largest civil litigation ever in the United States, something called the Master Settlement Agreement came about. It was an agreement between 46 states who sued the four big tobacco companies. There was a settlement for over $200 billion. It’s so much money. It’s hard to–
Denver: Even today!
Robin: Still a lot of money! Most of the money went and still goes to the 46 states that were part of the suit, but part of the agreement in that settlement was to carve out a pot of money to create an organization– It was then called the American Legacy Foundation– to dedicate itself to the education of young people, primarily to advance smoking prevention in the United States. And the wonderful thing about it is we get to use the tobacco industry’s money– with no strings attached– to basically say “Let’s put them out of business!”
Denver: Ain’t that sweet? So let’s take a look back. What was the prevalence of teen smoking back in 2000? And what would it be today?
Robin: When the Truth Campaign first started… so this is in 2000… 23% of teens… 8th-, 10th-, 12th graders in the United States smoked.
Denver: One out of four.
Robin: That’s pretty incredible, right? I mean, now, we think about that; it’s just mind-blowing. Today, the percent of 8th-, 10th-, 12th graders who smoke is 6%. That’s cigarettes. Now, there are some other things involved there too, but to get from 23% to 6% in 17 years is…It has been called one of the most dramatic successes in public health history ever.
Denver: It sure is. Now, are there certain communities where the incidence is higher and where the tobacco industry might be targeting their efforts?
Robin: Yes, for sure. So 6% is an average. But tobacco is not an equal opportunity killer. What the tobacco industry is very clever about is…you know, they would call it targeting; I’d actually call it profiling in terms of singling people out based on who you are, where you live, how much you have, and even whom you love, and marketing their products to them.
So, for example, among LGBT youth, the rates of tobacco use are twice as high as for the general population. Or, if you look at people of lower income, lower education – low SES is what we would say – the rates of tobacco use are incredibly higher. And that’s no accident because you’ll find, like for instance, 10 times more advertising for tobacco in an African-American neighborhood in some cities than in other neighborhoods. And as a person whose background was in marketing, I can tell you, advertising works. If you put 10 times more in the neighborhood, it’s going to have an impact.
Denver: Well, that’s all shameful, but maybe even more so is that they really have targeted those who are suffering from some degree of mental illness.
Robin: Yes. So we know that 40% of the cigarettes actually bought and consumed in the United States are among people with some kind of behavioral health issue – again, not an accident –and that’s people with depression, anxiety, substance abuse users. There’s actually evidence that says for a lot of these people, their ability to recover… and if they’re on medication…would actually be better if they didn’t smoke. But sometimes even the medical community doesn’t know that.
Denver: Well, you know, public health campaigns that have been targeting youth to choose healthy behaviors and healthy lifestyles, they have failed miserably forever and a day. And in fact, Tina Rosenberg, who was on the show recently and writes the “Fixes” column for the New York Times, said that many of these efforts have exactly the opposite effect… and encouraged that unhealthy behavior. So what has the Truth Initiative done that has made this so darn effective in reaching this market and changing their behavior for the better?